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Thursday, 16 May 2013

The strongest pro-choice argument: comments on J. Savulescu (2013)

This is the first installment in my series "The strongest pro-choice argument", which will focus on analyzing and responding to Volume 39, Issue 5 of the Journal of Medical Ethics. Issue 5 is a special publication which has been made available to the public as an expansion to the article "After-birth abortion: why should the baby live?", which was recently published by Giubilini and Minerva.

This is a very good introduction by the editor of the JME. He briefly describes the controversy around Giubilini and Minerva's 2012 publication, but like so many academics, is barely able to hide is confusion with regards to why the article stirred up such an intense, angry backlash. He understands disagreements, but not name-calling or death threat.s I think this is both the greatest virtue and greatest flaw of the academic mind. Passion is incomprehensible, while, at the same time (and perhaps due to this), reasoned discourse is the highest of achievements. As a scientist, I can certainly agree that emotions should be curtailed as much as possible, but I truly hope I never reach a point where anger is both an unexpected and incomprehensible reaction to advocacy for the legal killing of human beings without reference to medical justification or acknowledgement of other viable option. One can imagine a mother or father reading the Giubilini and Minerva article, and being enraged and saddened at the suggestion that their newborn's life is not worthy of government protection, simply because he or she is young. Can we really blame them for acting irrationally after being confronted with such a view? I myself cried the first time I read the after-birth abortion paper. Of course, I waited until I was more rational before commenting on the article, but can we really fault those who did not wait? Especially if they have not been trained in academic discourse?

Indeed, I think it ridiculous that such reactions are even mentioned in an academic journal, which should only focus on rational, well-written arguments. Instead, we are treated to references towards the most extreme and hateful reactions towards the article. This is a clever and subtle way of linking all those who drastically disagree with Giubilini and Minerva (i.e.: pro-lifers) with the few who thought putting death threats into print as perfectly acceptable.

Of course, what seems perfectly acceptable depends on how one views this issue. I realize pro-choicers find this exceedingly hard to believe (indeed, contributing authors touch on this later on in the journal issue) but many pro-lifers really do view a human embryo as having an equal claim to right to life as a human adult. Many more "mushy" pro-choicers and nomincal pro-lifers view 3rd trimester fetuses and newborn babies as having an equal claim to right to life as a human adult. And many more people irrationally consider birth as the moment when human beings recieve an intrinsic right to life which lasts, unchanging, throughout the rest of a human's life. So if it is widely agreed that newborns, at the least, have a right to life equal to that of a human adult, then let us take this parallel a step further. Imagine that instead of infanticide, the authors had argued in favour of something as horrific as Nazi Germany's medical experiments during WWII. Would the article have even been published? If it had, would immediate legal action for "hate speech" or "incitement towards violence" have occurred? Would anyone have faulted those who sent violent mail to the authors? Indeed, would any of us fault a WWII contemporary for sending death threats to Hitler or his medical researchers?

While such reactions, in my opinion, should not be a part of public discourse (EVER), I don't think any of us would consider such people to be "in the wrong". Those of us who are anti-infanticide indeed view newborns as having equal value as the Jews who died during the Holocaust (though undoubtably mental and physical torture prior to killing is far worse than a quick death - but if Hitler had killeed the Jews swiftly, cleanly, and painlessly, would any of us spare him even a single shred of respect?) so of course we pro-lifers are absolutely horrified and our immediate reaction is to view Giubilini and Minerva as horribly evil monsters. Of course, rational discourse, understanding, andcompassion is ALWAYS the best way to proceed, so such feelings should be curbed as quickly as possible, but I do maintain that they are perfectly reasonable initial responses. If we view newborns as equal to adults, then indeed this controversial paper is hate speech of the worste kind, directed towards some of the youngest and most defenseless of our peers.

[Aside: I apologize for using the tired example of Nazi Germany above - but sometimes it really can be used to make a point. Hopefully, I have succeeded here. Let me know if you think it would make more sense to word things differently, I want to make sure my thoughts are as clear and coherent as possible!]

All this being said, Savulescu definitely has some interesting points with regards to euthanasia, though I do think that he conflates the two issues of euthanasia and "after-birth" abortion. In my understanding, euthanasia can be interpreted as "palliative killing" and this definition does not apply in the case of a healthy newborn being targeted for death. That being said, euthanasia of infants has been practiced throughout human history - often openly and legally (ex: the Groningen Protocol in the Netherlands). The point Savulescu successfully makes is that different cultures disagree on if/when it is acceptable to kill newborns, even today in our "enlightened" society. Apparently, when infanticide can be considered moral or immoral is a conversation worth having.

Obviously, I think that this is an absolutely horrifying conversation to have, but unfortunately the situation today is such that this is a necessary (even critical) debate to engage in.

Other thoughts:

1. Savulescu discusses how, in neonatal intensive care, if doctors withdraw treatment the death of the baby is not a crime, but if the parents take it upon themselves to remove treatment, the infants death is considered a homicide. The author argues that the morality of an action should not depend on the person doing it (he compares ending life-extending treatment to running). I believe he over-simplifies the issue here. There are countless examples of when the "goodness" or "badness" of an action depends on the people involved. For instance, if an adult punches a child, we rightly consider that action deplorable, but if two siblings, especially below the age of 10, get into a fist fight, I would consider these children undisciplined but kind of adorable (how many youtube videos of kids punching each other have gone viral? Answer: lots.) Besides, the action of running is (literally) morally neutral and depends heavilyt on circumstance. Running away from commitments? Wrong. Running to win a race? Commendable.
I always thought that the reason only doctors (with the permission of the parents of course) can withdraw treatment is because they are trained to know when/if care is futile. If my child were in intensive care, I would not know if their situation was hopeless or not, but their doctor should know - in fact, it is the doctor's job to know. Allowing non-experts to refuse/discontinue treatment runs the very obvious risk of patients who would otherwise recover, dying instead. I would think that it is obvious that this risk is not ok.

2. The example of Jim, who rescues a drowning person, is awful. In one case, he swims to save the person, but changes his mind and lets go, allowing the person to drown. In the other case, he rescues the person using his boat, and then changes his mind and throws the person overboard.
I fail to see any moral distinction between these actions. In each case, Jim has the ability to save the drowning person, and begins a rescue effort. Assuming Jim's own life is never put into danger by the rescue effort, Jim's change of heart is deplorable in both cases. why does the presence of a boat make a difference?

3. Apparently, there is reason to believe that the circumstances where death is considered ok is less stringent for newborns vs. older children. I was not aware of this, and if true, this is very tragic. To quote "societal antipathy to infanticide is not as strong as it might seem at first glance." Perhaps society's reactions to infanticide are not as strong as our reactions to the murder of older children, but that hardly indicates that one is inuitively 'more ok" than the other, or that one entity has more of a right to life than the other. Consider a parallel situation where a three year old has disappeared, and then is found murdered. Now compare that situation with the disappearance and death of a thirty year old. Which is "intuitively" more horrifying? Considering the sensation the first situation often creates in the media, it seems that most of us react more viscerally to a young child's disappearance and death. But is the three year old more intrinsically valuable than the thirty year old? While some might disagree, I would hazard to say no. While it is more unfair to die when young, I don't think that an adult would be required to give his or her life to save a three year old, and the laws reflect that. Ergo, neither life is more valuable.
A better example would be the difference in societal reactions to crimes against white women or girls vs. crimes against ethnic women or girls. It seems that a greater sensation is created in the media by the first scenario. But are whites more valuable than other races? Obviously, the answer is a vehement no, and the presence of a Missing White Women Syndrome in our culture is deplorable.

4. I LOVE that this guy is in favour of embryo adoption! Based on his statements about a newborn being easily adopted by others as a reason not to resort to infanticide, is Savulescu also against abortion post-viability? Does he realize that he is basing a right to life on properties extrinsic to the individual, while it is my impression that most philosophers agree that such a right should be based on intrinsic properties? I do think a coherant case could be made, it just wasn't well-stated here. I'm sure, however, that more details are provided later in this journal issue.

Overall Impression: very good summary of this debate.

Most Important Quotation: Savulescu summarizes the position of the after-abortion paper [emphasis my own]

"Giubilini and Minerva extend the long-running debate on infanticide to ask: if abortion is permissible both for social as well as medical reasons, why is infanticide permissible only for medical reasons (assuming that selective non-treatment is a form of infanticide)? They ask: what is the moral difference between a fetus and a neonate? As McMahan points out in this issue, there is at least a 4-month period during which a human being could be either a fetus or an infant, depending on whether delivery has yet taken place. Giubilini and Minerva point out that both have similar capacities and if one is permissible, why not the other? The presence of disease or disability should not make a difference to moral status, so if infanticide is permissible for medical reasons, why is it not permissible for social reasons?"